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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EPediatric diabetes patients should be screened for celiac disease, thyroid disease, dyslipidemia and microalbuminuria when certain indications are present. These diseases are all serious and can effect the treatment of diabetes. Diabetes may also mask their presence and complicate their effects.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ediabetes mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Elipid disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ethyroid disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EPediatric diabetes patients should be screened for celiac disease, thyroid disease, dyslipidemia and microalbuminuria when certain indications are present. These diseases are all serious and can effect the treatment of diabetes. Diabetes may also mask their presence and complicate their effects.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECeliac diseases\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EIn type 1 diabetics (T1D), celiac disease (CD) causes unexplained hypoglycemia. Up to 16% of T1D patients develop autoantibodies to tissue transglutinase (TG IgA), a marker of CD. 70\u201390% of T1D patients have a positive intestinal biopsy for CD (Rewers et al. 2004).\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EMarian Rewers, MD, University of Colorado Medical Center, Denver, CO, recommends that T1D patients be screened for TG IgA at onset of diabetes and at least bi-annually until age 10, or if symptomatic. In symptomatic cases, a biopsy should be recommended. All patients whose CD biopsy was positive should be put on a gluten-free diet, regardless of symptoms. A patient\u0027s insulin dose usually needs to be increased when he\/she is on a gluten-free diet.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EThyroid disease\u003C\/h2\u003E\n         \u003Cp id=\u0022p-5\u0022\u003E15\u201330% of patients with type 1 diabetes have hypothyroidism. The coexistence of T1DM and autoimmune thyroid disease (AITD) is considered autoimmune polyglandular syndrome (APS Type III), explained Linda DiMeglio, MD, MPh, Riley Hospital for Children, Indianapolis, IN. Autoimmune thyroiditis is associated with human leukocyte antigen [HLA] genotype as well, which may be synergistic with HLA type for development of both T1DM and TAI.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003E\u201cIt is important to know the thyroid status of patients with T1DM because untreated hypothyroidism results in reduced insulin degradation and could cause hypoglycemia,\u201d said Dr. DiMeglio.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EHyperthyroidism affects only one percent of those with T1D, with Graves\u0027 disease being the most common cause of hyperthyroidism in young children and adults. Hyperthyroidism can be associated with worsening glycemic control and thyrotoxicosis may reveal latent diabetes mellitus.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003ESerum thyroid stimulation hormone (TSH) is the most reliable and sensitive screening test for thyroid dysfunction.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ELipid Profiles\u003C\/h2\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EDyslipidemia in childhood is a risk factor for development of atherosclerosis and increased cardiovascular (CV) risk. The goals of identifying and treating dyslipidemia are to prevent or delay atherosclerosis and to diminish CV risk associated with diabetes and dyslipidemia (\u003Cem\u003ENEJM\u003C\/em\u003E 1998).\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EThe ADA recommends performing a lipid profile after diagnosis of diabetes in children over age 2 years, and when glucose control has been established. If values are considered low risk and there is no family history, assessments should be repeated every 5 years.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003E\u201cThe primary goals of lipid screening in children and adolescents are to identify abnormalities, intervene and diminish CV risk,\u201d explained Kenneth Jones, MD, University of California, San Diego. \u201cDiabetes and dyslipidemia contribute to the acceleration of atherosclerosis and increase CV risk, and this process begins in childhood.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EMany young individuals with obesity and T2 diabetes have the dyslipidemia of insulin resistance, with its attendant risks. The treatment of familial hypercholesterolemia (FHC) with statins is safe and efficient and improves signs of vascular injury (\u003Cem\u003ELancet\u003C\/em\u003E 2004), according to Dr. Jones.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003E\u201cThere is a pressing need to identify lipid abnormalities in young people and study the safety and benefits of intervention,\u201d he concluded.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-5\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EMicroalbuminuria\u003C\/h2\u003E\n         \u003Cp id=\u0022p-14\u0022\u003ERisk factors for microalbuminuria (MA) are early onset of diabetes, long duration of diabetes, poor glycemic control, family history of nephropathy, smoking, autonomic neuropathy or retinopathy, poor diet, lack of exercise and hyperlipidemia. A rise in BP (hypertension) does not precede MA.\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003E\u201cThose who develop TID before puberty appear to be in a latent period followed by more rapid development of MA with pubertal onset,\u201d explained Denis Daneman, MD, Hospital for Sick Children, Toronto, Canada.\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EAccording to Dr. Daneman, extrapolations from adult and adolescent studies may be misleading, which indicate that studies of natural history of diabetes-related complications starting in pre-pubescent children are warranted.\u003C\/p\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EThese four complications can all affect the outcome of diabetes treatment and care, and should be screened in pediatric diabetes patients, according to guidelines developed by ADA and other organizations, in order to avoid further complications.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2006 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/6\/2\/30.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm0qp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}